Melissa L Anderson

Kaiser Permanente Washington Health Research Institute

Introduction: In the USA, patients who undergo genetic testing for hereditary cancer risk are responsible for informing relatives about their genetic test results, but many relatives never find out they might be at risk. A health system-mediated relative notification program might help fill this gap, but questions remain about the acceptability of...

In the United States, adherence for cervical cancer screening decreased from 86% to 77% between 2005 and 2019. Over 50% of cervical cancers are diagnosed in individuals overdue for screening, and promoting access and adherence is essential. Unlike traditional Papanicolaou testing, human papillomavirus (HPV) screening can use self-collected samples,...

Background Undiagnosed hypertension and uncontrolled blood pressure (BP) are common and contribute to excess cardiovascular morbidity and mortality. We examined whether BP control, changes in BP, and patient behaviors and attitudes were associated with a new hypertension diagnosis. Methods We performed a post hoc analysis of 323 participants from...

Importance Optimal strategies for increasing cervical cancer screening may differ by patient screening history and health care setting. Mailing human papillomavirus (HPV) self-sampling kits to individuals who are overdue for screening increases adherence; however, offering self-sampling kits to screening-adherent individuals has not been evaluated...

6646 Background: Patients with cancer face potentially high out-of-pocket costs associated with their medical care, which may lead to adverse medical and financial outcomes. Depending on their health insurance plan, patients may have to pay several thousands for medical care costs until they reach the annual maximum out-of-pocket [MOOP] spending li...

Importance: Human papillomavirus (HPV) self-sampling addresses barriers to cervical cancer screening, and mailed self-sampling kits have been reported to increase screening uptake. International research suggests mailed kits are cost-effective in certain settings. However, the cost-effectiveness of mailing HPV self-sampling kits for increasing scr...

Background The US Preventive Services Task Force recommends measuring blood pressure (BP) outside of clinic/office settings. While various options are available, including home devices, BP kiosks, and 24-h ambulatory BP monitoring (ABPM), understanding patient acceptability and adherence is a critical factor for implementation.Objective To compare...

Background: Over 14,000 cervical cancers are diagnosed annually in the U.S. In 2019, ~30% of individuals with a cervix were under-screened based on current guidelines. Previous studies established feasibility of mailed self-sampling high-risk HPV test kits to improve screening adherence. Qualitative findings from our HOME trial found unmet informat...

Background: Mailing HPV self-sampling kits to overdue individuals increases cervical cancer screening adherence; offering self-sampling to previously adherent individuals has not been evaluated in the U.S. Given heterogeneity of the U.S. health system and population, data are needed to optimize how HPV self-sampling is offered to individuals who a...

262 Background: Patients diagnosed with cancer experience intense medical care and high costs associated with the disease and its treatment. As a result, patients may consider changes to their health insurance coverage to adjust the medical benefits covered and/or the cost-sharing (e.g., annual maximum out-of-pocket [MOOP] limit) requirements. The...

172 Background: CAFÉ is a three-arm randomized controlled trial testing whether financial navigation for people with cancer improves quality of life and financial distress compared to enhanced usual care at two integrated health systems (Kaiser Permanente Washington, KPWA; and Kaiser Permanente Northwest, KPNW). Our current objective was to describ...

Both mindfulness-based stress reduction (MBSR) and cognitive-behavioral therapy (CBT) are effective for chronic low back pain (CLBP), but little is known regarding who might benefit more from one than the other. Using data from a randomized trial comparing MBSR, CBT, and usual care (UC) for adults aged 20-70 years with CLBP (N = 297), we examined b...

Importance: Undiagnosed hypertension contributes to excess morbidity and mortality. Objective: To examine the effect of hypertension diagnostic testing on hypertension diagnoses and blood pressure (BP) control months at 6 months. Design, Setting, and Participants: BP CHECK was a randomized diagnostic study of 510 adults aged 18-85 without diagnosed...

Background: Little information is available as to whether undergoing hypertension diagnostic testing or receiving a new diagnosis of hypertension leads to psychological distress. Design, Setting, and Participants: BP CHECK was a randomized diagnostic study of 510 adults aged 18-85. Participants had elevated BP in clinic at baseline but no previousl...

Background Genetic testing for pathogenic variants associated with hereditary breast and ovarian cancer risk can improve cancer outcomes through enhanced preventive care in both people with known variants and their biologic relatives. Cascade screening—the process of case-finding in relatives by notifying and inviting them to consider testing—curre...

Background There is an urgent need for evidence on how interventions can prevent or mitigate cancer-related financial hardship. Our objectives are to compare self-reported financial hardship, quality of life, and health services use between patients receiving a financial navigation intervention versus a comparison group at 12 months follow-up, and...

Background: The US Preventive Services Task Force recommends blood pressure (BP) measurements using 24-h ambulatory monitoring (ABPM) or home BP monitoring before making a new hypertension diagnosis. Objective: Compare clinic-, home-, and kiosk-based BP measurement to ABPM for diagnosing hypertension. Design, setting, and participants: Diagnos...

Background: Automated office blood pressure (AOBP) using three to five measurements taken with an oscillometric device with or without an attendant in the room may decrease "white coat" effect. We evaluated the impact of the presence or absence of the attendant and rest on BP and diagnosis of hypertension. Methods: We randomly assigned 133 adult...

Introduction: The US Preventive Services Task Force recommends out-of-office blood pressure (BP) measurement before making a new hypertension diagnosis and initiating treatment, using 24-hour ambulatory (ABPM) or home BP monitoring. However, this approach is not common. Methods: e-mail-linked surveys were sent to primary care team members (n = 4...

Purpose: We undertook a study to assess whether implementing 7 evidence-based strategies to build improvement capacity within smaller primary care practices was associated with changes in performance on clinical quality measures (CQMs) for cardiovascular disease. Methods: A total of 209 practices across Washington, Oregon, and Idaho participated...

Women overdue for cervical cancer screening often have other preventive care gaps. We examined whether mailing unsolicited human papillomavirus (HPV) self-sampling kits to increase cervical cancer screening impacted receipt of other preventive services women were due for: mammography, colorectal cancer (CRC) screening, influenza vaccination, depres...

Importance: Age-related hearing difficulties can include problems with signal audibility and central auditory processing. Studies have demonstrated associations between audibility and dementia risk. To our knowledge, limited data exist to determine whether audibility, central processing, or both drive these associations. Objective: To determine...

338 Background: Identifying participants for time-sensitive clinical trials such as those with newly diagnosed cancer presents challenges. Manual identification methods, the current standard, can be resource intensive and present challenges with data collection, quality assurance and can introduce bias to the selection process. Electronic health re...

Introduction Limited evidence-based implementation strategies exist for maintaining lung cancer screening. We evaluated the Lung Cancer Screening Program at Kaiser Permanente Washington (KPWA) to develop multilevel interventions to improve screening adherence. Methods We conducted a concurrent mixed-methods study 1) to measure adherence to repeat...

Background Screening over many years is required to optimize colorectal cancer (CRC) outcomes.Objective To evaluate the effect of a CRC screening intervention on adherence to CRC screening over 9 years.DesignRandomized trial.SettingIntegrated health care system in Washington state.ParticipantsBetween August 2008 and November 2009, 4653 adults in a...

Context: Automated office blood pressure (AOBP) where three to five blood pressures (BP) are taken using an oscillometric device without an attendant in the room may decrease white coat effect. Objective: We evaluated the presence/absence of the attendant and varying amounts of rest time on BP; and the diagnostic performance of AOBP in making a new...

Context: The US Preventive Services Task Force recommends out-of-office blood pressure (BP) measurement before making a new diagnosis of hypertension, using 24-hour ambulatory (ABPM) or home BP monitoring. However, this approach is not common in routine practice. Objective: To evaluate provider knowledge, beliefs, and practices about BP diagnostic...

Purpose: To assess whether primary care practices with and without support from a larger organization differ in their ability to produce timely reports on cardiovascular disease quality measures. Background: Although many primary care practices are now part of larger organizations, it is not clear whether such a shift will improve the ability of...

Background: The authors tested the efficacy of the "I-STAND" intervention for reducing sitting time, a novel and potentially health-promoting approach, in older adults with obesity. Methods: The authors recruited 60 people (mean age = 68 ± 4.9 years, 68% female, 86% White; mean body mass index = 35.4). The participants were randomized to receive...

Background: Proportion of time covered (PTC, or "covered time") is a longitudinal measure of adherence to preventive health services, the use of which has increased in recent years. This measure is helpful for evaluating the success of delivering screening interventions over time. However, there are challenges and nuances in computing and interpre...

Background: Healthy Hearts Northwest (H2N) is a study of external support strategies to build quality improvement (QI) capacity in primary care with a focus on cardiovascular risk factors: appropriate aspirin use, blood pressure control, and tobacco screening/cessation. Methods: To guide practice facilitator support, experts in practice transformat...

Background: Healthy Hearts Northwest (H2N) is a study of external support strategies to build quality improvement (QI) capacity in primary care with a focus on cardiovascular risk factors: appropriate aspirin use, blood pressure control, and tobacco screening/cessation. Methods: To guide practice facilitator support, experts in practice transformat...

Purpose: We conducted a randomized controlled trial to compare the effectiveness of adding various forms of enhanced external support to practice facilitation on primary care practices' clinical quality measure (CQM) performance. Methods: Primary care practices across Washington, Oregon, and Idaho were eligible if they had fewer than 10 full-tim...

Background: Healthy Hearts Northwest (H2N) is a study of external support strategies to build quality improvement (QI) capacity in primary care with a focus on cardiovascular risk factors: appropriate aspirin use, blood pressure control, and tobacco screening/cessation. Methods: To guide practice facilitator support, experts in practice transfor...

Importance Colorectal cancer screening rates are suboptimal, particularly among sociodemographically disadvantaged groups. Objective To examine whether guaranteed money or probabilistic lottery financial incentives conditional on completion of colorectal cancer screening increase screening uptake, particularly among groups with lower screening rat...

Background Healthy Hearts Northwest (H2N) is a study of external support strategies to build quality improvement (QI) capacity in primary care with a focus on cardiovascular risk factors: appropriate aspirin use, blood pressure control, and tobacco screening/cessation. Methods To guide practice facilitator support, experts in practice transformatio...

Purpose To estimate changes in self-reported health and psychosocial factors associated with a 12-week sedentary behavior intervention for older adults. Design Exploratory secondary analysis of pilot randomized controlled trial. Setting Kaiser Permanente Washington Subjects Sixty adults aged 60 to 89 with body mass index ≥30 kg/m². Intervention...

Background: The US Preventive Services Task Force recommends out-of-office blood pressure (BPs) before making a new diagnosis of hypertension, using 24-h ambulatory (ABPM) or home BP monitoring (HBPM), however this is not common in routine clinical practice. Blood Pressure Checks and Diagnosing Hypertension (BP-CHECK) is a randomized controlled di...

Background: Past research has focused on risk factors for developing dementia, with increasing recognition of "resilient" people who live to old age with intact cognitive function despite pathological features of Alzheimer's disease (AD). Objective: To evaluate demographic factors, mid-life characteristics, and non-AD neuropathology findings tha...

Smokers are at high risk of oral disease and report sub-optimal oral hygiene. Improving smokers’ oral hygiene could reduce their future disease risk. The purpose of this study is to assess the effects of a novel, multi-modal oral health promotion program (Oral Health 4 Life; OH4L) targeted to socioeconomically disadvantaged smokers and delivered th...

Background Smokers are at increased risk of oral disease. While routine dental care can help prevent and treat oral health problems, smokers have far lower rates of dental care utilization compared with non-smokers. We sought to better understand which factors may facilitate or hinder dental care utilization among low-income smokers participating i...

Background: Prolonged sitting is associated with adverse aging-related outcomes. Few interventions have tested whether sitting patterns can be altered in older adults with obesity. We tested the impacts of a sitting reduction intervention (I-STAND) in a pilot randomized controlled trial. Methods: Participants (N = 60, mean age = 68.4, 68% female, 8...

Objective: We assessed the relationship between diabetes mellitus (DM) and measures of worker productivity, direct health care costs, and costs associated with lost productivity among health care industry workers across two integrated healthcare systems. Methods: We used data from the Value Based Benefit Design Health and Wellness Study Phase II...

Background: Anticholinergic medication exposure has been associated with increased risk for dementia. No study has examined the association between anticholinergic medication use and neuropathologic lesions in a community-based sample. Objective: To examine the relationship between anticholinergic exposure and dementia-related neuropathologic ch...

Objectives: To assess the effects of a novel oral health promotion program (Oral Health 4 Life; OH4L) delivered through state-funded tobacco quitlines. Methods: Using a semipragmatic design to balance experimental control and generalizability, we randomized US quitline callers (n = 718) to standard care or standard care plus OH4L. We followed pa...

Background: Older adults have high rates of obesity and are prone to chronic health conditions. These conditions are in part due to high rates of sedentary time (ST). As such, reducing ST could be an innovative strategy for improving health outcomes among obese older adults. To test this theory, we developed a novel, technology-enhanced interventi...

Background: Most smokers do not use evidence-based smoking cessation treatment. Increasing utilization of these services is an important public health goal. Health care systems and insurers are well positioned to support this goal within their patient populations. We tested whether a brief, mail-based intervention increased utilization of tobacco...

Objectives: To determine whether higher cumulative proton pump inhibitor (PPI) exposure is associated with greater dementia risk. Design: Prospective population-based cohort study. Setting: Kaiser Permanente Washington, an integrated healthcare delivery system in Seattle, Washington. Participants: Individuals aged 65 and older without dement...

Abstract Background Mechanisms linking cognitive and physical functioning in older adults are unclear. We sought to determine whether brain pathological changes relate to the level or rate of physical performance decline. Methods This study analyzed data from 305 participants in the autopsy subcohort of the prospective Adult Changes in Thought (ACT...

Importance: The US Preventive Services Task Force recommends screening adults for high blood pressure (BP). If BP is high, out-of-office BPs are recommended before making a new diagnosis of hypertension, preferably using 24 hour ambulatory BP monitoring (ABPM), because over 30% have normal BPs outside of clinic or “White coat” hypertension with ris...

Background: Screening over many years is required to optimize reductions in colorectal cancer (CRC) mortality. However, no prior trials have compared strategies for obtaining long-term adherence. Methods: Systems of Support to Increase Colorectal Cancer Screening and Follow-Up was implemented in an integrated health care organization in Washingt...

Study design: Economic evaluation alongside a randomized trial of cognitive-behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) versus usual care alone (UC) for chronic low-back pain (CLBP). Objective: Determine the one-year cost-effectiveness of CBT and MBSR compared to UC. Summary of background data: CLBP is expensive in t...

We compared the effectiveness of two outreach strategies on timely mammography adherence: a mammogram-specific reminder letter (sent just before a woman was due) to a birthday letter (addresses multiple preventive services and not timed around due dates). We evaluated screening mammography adherence following 79,848 mammogram-specific and 151,626 b...

Objective We evaluated dementia and Alzheimer’s disease (AD) risks after a cancer diagnosis in a population-based prospective cohort, the Adult Changes in Thought (ACT) study. Methods We followed community-dwelling people aged ≥65 years without dementia at study entry for incident dementia and AD from 1994–2015. We linked study data with cancer re...

Parents who refuse or delay vaccines because of vaccine hesitancy place children at increased risk for vaccine-preventable disease. How parental vaccine hesitancy changes as their children age is not known. In 2015, we conducted a follow-up survey of 237 mothers enrolled in a 2-arm clinic-level cluster randomized trial (n = 488) in Washington State...

Background: Opioids may influence the development of Alzheimer's disease (AD). Some studies have observed AD pathology in the brains of opioid abusers. No study has examined the association between prescription opioid use and dementia-related neuropathologic changes. Objective: To examine the relationship between prescription opioid or NSAID use...

Smokers are at high risk for oral disease. As a result, they represent an important target group for population-level, public oral health promotion efforts. While dental health professionals often address smoking with their patients, no systematic efforts have been made to offer smokers an intervention to improve their use of oral health care. This...

OBJECTIVE Systematic multidisciplinary approaches to improving quality and safety in complex surgical care have shown promise. Complication rates from complex spine surgery range from 10% to 90% for all surgeries, and the overall mortality rate is 1%–4%. These rates suggest the need for improved perioperative complex spine surgery processes designe...

Colorectal cancer (CRC) is the second-leading cause of cancer deaths. Mortality could be rapidly reduced through higher uptake and adherence to CRC screening. Information on long-term screening adherence comes from organized programs that lack a comparison group. Objective: Systems of Support to Increase Colorectal Cancer Screening is an ongoing tr...

The need for effective treatment options for chronic low back pain has spurred interest in “mind-body” approaches including cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR). We previously reported that, compared with usual care, MBSR and CBT reduced functional limitations and pain bothersomeness for up to 1 year amon...

Purpose The aim of this study was to assess agreement of mammographic interpretations by community radiologists with consensus interpretations of an expert radiology panel to inform approaches that improve mammographic performance. Methods From 6 mammographic registries, 119 community-based radiologists were recruited to assess 1 of 4 randomly ass...

Background/Aims: The economic burden of diabetes mellitus is high in the United States, increasing health care utilization and reducing workforce participation. Worker productivity is adversely impacted by complications related to diabetes. Estimating rates of absenteeism, presenteeism and other productivity measures can quantify the impact of diab...

Background/Aims: Studies have demonstrated conflicting results about the association between anesthesia exposure and subsequent dementia risk. However, prior studies were retrospective, collecting data on anesthesia exposure after determining dementia status. We used prospectively collected data to evaluate the associations between anesthesia and r...

Background/Aims: Delivery system-based research in enumerated populations provides a unique opportunity to study complex chronic diseases as they develop. Studies of disorders that affect people late in life can be particularly valuable. The Adult Changes in Thought (ACT) study was recently awarded five more years of funding. This makes ACT one of...

Importance Familial hypercholesterolemia (FH) is characterized by elevated cholesterol concentrations early in life. Untreated FH is associated with premature cardiovascular disease in adulthood. Objective To systematically review the evidence on benefits and harms of screening adolescents and children for heterozygous FH for the US Preventive Ser...

Background Mobile health (mHealth) interventions hold great promise for helping smokers quit since these programs can have wide reach and facilitate access to comprehensive, interactive, and adaptive treatment content. However, the feasibility, acceptability, and effectiveness of these programs remain largely untested. Objective To assess feasibili...

Background: In 2003, Group Health implemented a pharmacy-based, systemwide outreach effort to increase the preventive use of statins and angiotensin-converting enzyme inhibitors in enrollees at risk for cardiovascular disease, including all enrollees with diabetes. Objective: To estimate the associations between the use of statins and major vasc...

Cognitive-behavioral therapy (CBT) is believed to improve chronic pain problems by decreasing patient catastrophizing and increasing patient self-efficacy for managing pain. Mindfulness-based stress reduction (MBSR) is believed to benefit chronic pain patients by increasing mindfulness and pain acceptance. However, little is known about how these t...

Background: Cancer is the second leading cause of death in the United States. Purpose: To conduct systematic reviews of aspirin and 1) total cancer mortality and incidence in persons eligible for primary prevention of cardiovascular disease (CVD) and 2) colorectal cancer (CRC) mortality and incidence in persons at average CRC risk. Data sources...

Importance: Mindfulness-based stress reduction (MBSR) has not been rigorously evaluated for young and middle-aged adults with chronic low back pain. Objective: To evaluate the effectiveness for chronic low back pain of MBSR vs cognitive behavioral therapy (CBT) or usual care. Design, setting, and participants: Randomized, interviewer-blind, cl...

Objective: The patient-centered medical home (PCMH) includes comprehensive chronic illness and preventive services, including identifying patients who are overdue for colorectal cancer screening (CRCS). The association between PCMH implementation and CRCS during the Systems of Support to Increase Colorectal Cancer Screening Trial (SOS) is describe...

Objectives To evaluate the associations between anesthesia and dementia or Alzheimer's disease (AD) risk using prospectively collected data. DesignCohort study. ParticipantsCommunity-dwelling members of the Adult Changes in Thought cohort aged 65 and older and free of dementia at baseline (N = 3,988). MeasurementsParticipants self-reported all prio...

Objective To determine whether higher cumulative use of benzodiazepines is associated with a higher risk of dementia or more rapid cognitive decline. Design Prospective population based cohort. Setting Integrated healthcare delivery system, Seattle, Washington. Participants 3434 participants aged ≥65 without dementia at study entry. There were two...

Background: The current study was conducted to determine the effect of continuing a centralized fecal occult blood test (FOBT) mailed program on screening adherence. Methods: A patient-level randomized controlled trial was conducted in 21 patient-centered medical home primary care clinics between January 2010 and November 2012. A total of 2208 p...

In Reply Residual confounding refers to any bias arising from failure to adequately adjust for confounders: either unobserved covariates that are not included in the analysis or observed covariates that are inadequately included in the analysis due to measurement error or model misspecification. In our study, we controlled for confounding through r...

To determine whether prescription opioid use is associated with higher dementia risk or greater cognitive decline. Prospective cohort study. Group Health, an integrated healthcare delivery system. Community-dwelling individuals aged 65 and older without dementia with at least 10 years of Group Health enrollment at baseline (N = 3,434; median age 74...

Background: The US Preventive Services Taskforce (USPSTF) recommends routine lipid screening beginning age 35 for men [1]. For women age 20 and older, as well as men age 20-34, screening is recommended if cardiovascular risk factors are present. Prior research has focused on underutilization but not overuse of lipid testing. The objective is to do...